Clinical Development and Future Direction for the Treatment of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and about 600,000 patients suffer from HCC annually. The highest incidence is in Southeastern and Eastern Asia, with an incident rate of 18.3-35.5 per 100,000 population, and the lowest is in Central America with a rate of 2.1 per 100,000 population. HCC is one of the leading malignancies in Taiwan. Hepatitis B or C virus infections are the major factors for liver cancer in Taiwan. The survival time for patients with HCC without therapy after diagnosis averages 1-4 months. In this article, we review the risk factors, diagnostic criteria, staging systems, management and treatment of HCC. Treatments include liver transplantation, surgery, transcatheter arterial chemoembolization and transcatheter arterial embolization, percutaneous injection or radiofrequency ablation, chemotherapies, hormone therapy, internal radiation therapy, targeted therapy, a combination of chemotherapeutic agents and tyrosine kinase inhibitors, antiangiogenesis therapy, metabolic targets and Chinese herbal medicine. We propose three flow charts to guide surveillance, diagnosis, and treatment. Patients with high risk of HCC should be followed-up using the HCC High Risk Group Surveillance Flow Chart 1. If a mass is suspected, patients can be diagnosed using the HCC Diagnosis Flow Chart 2. On confirmation of HCC diagnosis, treatment should follow the HCC Treatment Flow Chart 3. Because the liver is the body's detoxification organ, its cells are already numerous with a high expression of the MDR gene. This makes chemotherapeutic drug treatment difficult. New molecular targeted therapy or new effective drugs are needed for difficult-to-treat HCC.